正常血压非胰岛素依赖型糖尿病病人血压昼夜节律与尿白蛋白排泄率的关系

目的：了解偶测血压正常的非胰岛素依赖型糖尿病（ＮＩＤＤＭ）病人血压水平及其昼夜节律与尿白蛋白排泄率（ＡＥＲ）的关系。方法：将５５例临床无高血压、无糖尿病肾病的ＮＩＤＤＭ病人按ＡＥＲ水平分为微量白蛋白尿组（ＭＡ组）和正常白蛋白尿组（ＮＡ组），同步测定２４小时动态血压和ＡＥＲ，分析比较其关系。结果：ＭＡ组偶测血压、白天血压、２４小时平均血压与ＮＡ组比较无显著差异，夜间血压和血压昼夜节律异常的发生率则明显高于ＮＡ组，而无明显血压昼夜节律者ＡＥＲ水平和微量白蛋白尿的发生率明显高于有昼夜节律者。结论：在偶测血压正常的ＮＩＤＤＭ病人，动态血压监测较偶测血压更易发现夜间血压异常，血压昼夜节律改变与ＡＥＲ的关系较２４小时平均血压更为密切。     

正常血压非胰岛素依赖型糖尿病病人血压昼夜节律与尿白蛋白排泄率的…

目的：了解偶测血压正常的非胰岛素依赖型糖尿病（ＮＩＤＤＭ）病人血压水平及其昼夜节律与水白蛋白排泄率（ＡＥＲ）的关系，方法：将５５例临床无高血压，无糖尿病肾病的ＮＩＤＤＭ病人按ＡＥＲ水平分为微蛋白蛋白尿组，（ＭＡ组）和正常白蛋白尿组（ＮＡ组）同步测定２４小时动态血压和ＡＥＲ，分析比较其关系，结果：ＭＡ组偶测血压，白天血压，２４小时平均血压与ＮＡ组比较无显著差异，夜间血压和血压昼夜节律异常的发生率则明     

非胰岛素依赖型糖尿病合并肾病患者有关因素分析(附163例报告)

目的：分析非胰岛素依赖型糖尿病肾病的相关因素。方法：对１６３例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者进行了２４小时尿白蛋白排泄量（ＵＡＥ／２４ｈ）、晨尿Ｎ－乙酰－β－Ｄ氨基葡萄糖苷酶（ＮＡＧ）、尿β２微球蛋白测定，并记录血压及病程，同时进行了眼底检查。结果：本文ＮＩＤＤＭ患者尿白蛋白排泄量与病程、血压、尿ＮＡＧ等相关。结论：ＮＩＤＤＭ患者尿白蛋白排泄量随病程延长、血压升高、尿ＮＡＧ增加而明显增加，且与糖尿病视网膜病变关系密切。     

尿NAG测定在早期糖尿病肾病疗效监控中的作用

目的：探讨尿Ｎ－乙酰－β－Ｄ－氨基葡萄糖苷酶（ＮＡＧ）在早期糖尿病肾病疗效监控中的意义,方法：测定早期糖尿病肾病患者治疗前后尿ＮＡＧ指数变化,选取尿ＮＡＧ指数升高的非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者８５例,据尿白蛋白排泄率（ＵＡＥ）情况分三组,进行常规降糖＋开搏通治疗,治疗期间监测尿ＮＡＧ指数和ＵＡＥ变化情况,结果：ＵＡＥ〈２００μｇ／ｍｉｎ的两组患者治疗后尿ＮＡＧ指数下降情况优于ＵＡＥ〉２０     

短期降糖、降压治疗对NIDDM患者尿蛋白排泄率的影响

尿白蛋白排泄率（ＵＡＥ）增高作为早期糖尿病肾病（ＤＮ）的敏感指标己被广泛关注。本文观测了８０例经短期住院治疗的非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者治疗前后血糖、血压及某些生化指标的变化，以了解纠正高血糖、高血压对ＵＡＥ的影响。１资料与方法１．１病例...     

血α_1微球蛋白含量测定在糖尿病肾病早期诊断中的临床意义

本文测定５０例Ⅱ型糖尿病（ＮＩＤＤＭ）患者血α_１微球蛋白（Ｓα_１－ＭＧ）、血β_２微球蛋白（Ｓβ_２－ＭＧ）、尿微量白蛋白（Ｕ－ＡＩｂ）和血肌酐（Ｓｃｒ）含量,并以３０例健康者作对照,探讨Ｓα１－ＭＧ含量变化在糖尿病肾病早期诊断中的临床意义。１临床资料 从本院内科门诊选择５０例符合ＷＨＯ关于糖尿病诊断标准且无肾脏自身病变或引起肾脏病变的其它疾病,以及Ｓｃｒ在正常范围的ＮＩＤＤＭ患者,将他们按照病程长短分为：糖尿病病程小于５年者称为ＤＭ（Ａ）组,共３０例,其中男１７例,女１３例,平均年龄 ５８．９３…     

超声心动图及多普勒超声探测非胰岛素依赖型糖尿病患者左室功能

应用超声心图及多普勒超声检测１０３例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者和５１例健康人左心室功能和结构参数。结果：各组ＮＩＤＤＭ患者左室舒张功能均有异常，收缩功能障碍仅见于伴大血管病变者。与正常人比较，糖尿病患者ＰＶＡ和ＰＶＡ／ＰＶＥ升高，ＰＶＥ和ＭＥＦ降低；ＬＶＳＴ、ＬＶＰＷＴ、ＬＶＭ和ＬＶＭＩ增加；伴大血管变者ＳＶ、ＣＯ及ＥＦ均减少。结论：ＮＩＤＤＭ患者常见左室功能障碍，甚至可见于无血管并发     

循环免疫复合物,脂蛋白与Ⅱ型糖尿病血管并发症的关系

测定了５４例Ⅱ型糖尿病（ＮＩＤＤＭ）病人（２０例有微血管病变，１８例有大血管病变，１６例无血管病变）及３３例正常人的血浆ＣＩＣ，Ｃ３，免疫球蛋白和脂蛋白。ＮＩＤＤＭ各组与正常对照组比较，ＣＩＣ，Ｃ３，ＩｇＧ，ＩｇＡ，ＬＤＬ－Ｃ，ＴＧ，ＴＣ均显著升高，ＩｇＭ，ＨＤＬ－Ｃ均显著下降。并且ＣＩＣ在ＮＩＤＤＭ并发血管病变组均显著高于ＮＩＤＤＭ无血管病变组，并发微血管病变，尤其与微血管病变组。提示ＮＩＤＤＭ     

超声心动图及多普勒超声探测非胰岛素依赖型糖尿病患者左心室功能

应用超声心动图及多普勒超声检测１０３例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者和５１例健康人左心室功能和结构参数。结果：各组ＮＩＤＤＭ恩者左室舒张功能均有异常，收缩功能障碍仅见于伴大血管病变者。与正常人比较，糖尿病患者ＰＶＡ和ＰＶＡ／ＰＶＥ升高，ＰＶＥ和ＭＥＦ降低；ＬＶＳＴ、ＬＶＰＷＴ、ＬＶＭ和ＬＷＩ增加；伴大血管病变者ＳＶ、ＣＯ及ＥＦ均减少。结论：ＮＩＤＤＭ患者常见左室舒张功能障碍，甚至可见于无血管并发症者，左室重量亦明显增加。超声心动图及多普勒超声可用于探测糖尿病患者心功能的早期异常并有助于糟尿病性心肌病的诊断。     

非胰岛素依赖型糖尿病（NIDDM）患者的骨密度改变

采用美国双能Ｘ线骨密度测定仪（ＤＥＸＡ）分别测定一组ＮＩＤＤＭ病人及一组非ＮＩＤＤＭ对照的全身、腰椎及髋关节的骨密度并进行比较，同时测定近期血糖水平。结果示本组ＮＩＤＤＭ患者的骨密度与非糖尿病对照组比较均有普遍增高的趋势，无骨质疏松的男性ＮＩＤＤＭ病人及无骨质疏松的绝经前女性ＮＩＤＤＭ患者的全身骨密度、次全身骨密度及第二腰椎骨密度明显升高，且病人的近期血糖控制与骨密度无关。     

Circadian rhythm of blood pressure in normotensive NIDDM subjects. Its relationship to microvascular complications

OBJECTIVE: To investigate the relationship between circadian rhythm of mean blood pressure (MBP) and microvascular complications in non-insulin-dependent diabetes mellitus (NIDDM) subjects. RESEARCH DESIGN AND METHODS: Seventy-six normotensive NIDDM subjects without azotemia were studied under ordinary hospital conditions with a noninvasive ambulatory blood pressure monitoring device. Time series data were analyzed by the cosinor method. RESULTS: Fifty-four subjects had a circadian MBP rhythm similar to that of 34 age-matched nondiabetic control subjects, with a peak value in the afternoon (group 1). In contrast, 22 had a reversed circadian MBP rhythm, with a peak value during the night (group 2). Obvious complications were found in 65% of group 1 and in all of group 2. The prevalence of retinopathy and somatic neuropathy and the degree of retinopathy were similar in the two groups. The prevalence and degree of autonomic neuropathy (postural hypotension and reduced beat-to-beat heart-rate variation) and nephropathy were greater in group 2 than group 1. Linear discriminant analysis revealed a correlation between the reversed circadian MBP rhythm and postural hypotension (F = 32.2, P less than 0.001) and overt nephropathy (F = 5.1, P less than 0.05) but not with beat-to-beat heart-rate variation (F = 0.17, NS). CONCLUSIONS: These results suggest that in the hospitalized normotensive NIDDM subjects, there are normal and reversed circadian MBP rhythms and that the reversal of normal circadian MBP rhythm may be related to the degree of postural hypotension and/or nephropathy.     

胰激肽释放酶对糖尿病心血管自主神经功能异常的疗效观察

目的：研究胰激肽释放酶对糖尿病心血管自主神经病变的治疗作用。方法：72个伴心率变异异常的糖尿病患者随机分为治疗组(38例)和对照组(34例)。以时域法和频域法评价治疗前后心率变异(HRV)改变。结果：对照组SDNN、SDNN index、HRV三角指数较入选时降低，随访前后的差值有显著差异；治疗组UAER较治疗前降低，余各指标差值无显著差异。结论：胰激肽释放酶可有效延缓糖尿病心血管自主神经病变的进展。     

Autonomic neuropathy in diabetes mellitus, chronic renal failure and liver cirrhosis

Chronic diseases (diabetes mellitus, end stage renal failure on hemodialysis, post-hepatitic liver cirrhosis) caused autonomic neuropathy in 34 of 65 cases. The frequency of autonomic neuropathy was 14 of 30 diabetics (typ I and typ II), twelve of 19 patients on dialysis, and eight of 16 non-alcoholic liver cirrhotics. We did not find a correlation between the tests of the cardiovascular and of the gastrointestinal system. The distribution of the neuropathic changes was undependent of the underlying disorder. Using appropriate tests, alterations of the autonomic functions can be discovered frequently even in asymptomatic patients. At least two pathological test results are necessary to reach a significant difference between patients and healthy controls. This indicates that the diagnosis of autonomic neuropathy should rely on two or more pathological test results. The evidence of autonomic neuropathy identifies a population of high risk patients.     

Features of angina pectoris in patients with non-insulin-dependent diabetes mellitus (NIDDM)

Detailed clinicofunctional examination of anginal patients with NIDDM using variation pulsometry and electrophysiological cardiac tests in 110 patients (89 females and 21 males aged 36-79 years, mean 64.3 +/- 5.2 years) has revealed that atypical cardialgia, arterial hypertension, obesity was present in 28.1, 76.4 and 85.4% of anginal patients with NIDDM. Sympathicotonia was registered in autonomic heart regulation of 83% of them. Anginal patients exhibited also suppression of sinus node automatism and sinoatrial conduction. When NIDDM is severe, pacemaker activity of the sinus node intensified suggesting development of cardial diabetic neuropathy.     

Heart rate variability in diabetes: relationship to age and duration of the disease

Heart rate variability (HRV) during deep breathing was studied with a neonatal heart monitor in 143 control subjects and 218 patients with diabetes (102 with IDDM and 116 with NIDDM). In the control group HRV decreased after age 20 by 4-5 beats per decade (from 29.7 +/- 5.8 beats at age 20-29 to 11.8 +/- 5.4 beats at age 60+). In all age groups HRV in IDDM was lower than in the controls, and both age and duration of diabetes played a role in the decrease of HRV (from 21.5 +/- 5.3 beats at age 20-29 to 6.3 +/- 5.4 at age 60+). In NIDDM aging seemed to play a less important role, and the influence of the duration of the disease was not statistically significant. In both groups of patients the frequency of HRV below the 2.5th percentile was 82% in those with symptoms and/or signs of autonomic neuropathy, 64% in patients with peripheral neuropathy only, and 36% in those who had no obvious signs or symptoms of neuropathy. Interindividual variability was pronounced, and age and duration of the disease together accounted for only 36% of the observed differences between IDDM and the controls. Determination of HRV with a standard neonatal heart monitor presents an easy, simple, and nonstressful test of cardiac autonomic neuropathy. The norms of the test are age related.     

伟素治疗微量白蛋白尿期糖尿病肾病的疗效

目的 探讨伟素对微量白蛋白尿期糖尿病肾病的疗效。方法 纳入年龄43—70岁，糖尿病病程6个月～30年，24h尿白蛋白排泄率（UAER）30．300mg的60例。微量白蛋白尿期糖尿病肾病（DN）患者60例，采用计算机随机分组方法将患者等分为3组：常规治疗组只予常规降糖治疗12周；氯沙坦钾组在常规降糖治疗同时每日晨15服氯沙坦钾50mg，12周；伟素组在常规降糖治疗的同时给予伟素600 LSU，qd，iv或im治疗4周，再以250 LSU bid，po序贯治疗8周。所检测指标包括尿白蛋白排泄率（UAER）、尿素氮（BUN）、肌酐（Cr）等。结果 常规治疗组UAER在治疗前后差异无统计学意义（P〉0．05）。而氯沙坦钾组和伟素组两组治疗前后差异有统计学意义（P〈0．01），治疗3个月后氯沙坦钾组UAER下降34．04％，伟素组下降33．62％。治疗后两组UAER与常规组比较差异有统计学意义（P〈0．01），但两组间同期比较差异无统计学意义（P〉0．05）。结论 伟素能够减少微量白蛋白尿期糖尿病肾病患者的尿白蛋白排泄率；与氯沙坦钾的疗效相当。     

Urinary excretion of angiotensin-converting enzyme in NIDDM patients with nephropathy

Twenty-four-hour urinary excretion of angiotensin-converting enzyme (ACE) was investigated in relation to that of albumin and beta 2-microglobulin (beta 2M) in 25 non-insulin-dependent diabetes mellitus (NIDDM) patients without nephropathy, 13 NIDDM patients with incipient nephropathy, 18 NIDDM patients with overt nephropathy, and 14 nondiabetic subjects. NIDDM patients without nephropathy and nondiabetic subjects were similar in albumin, beta 2M, and ACE excretion. NIDDM patients with incipient nephropathy had elevated albumin excretion (P less than .01) and similar beta 2M and ACE excretion compared with nondiabetic subjects. On the other hand, NIDDM patients with overt nephropathy had elevated albumin, beta 2M, and ACE excretion compared with nondiabetic subjects (P less than .01). In all NIDDM patients studied, a positive correlation was found between ACE excretion and albumin excretion (r = 0.76, P less than .001) or beta 2M excretion (r = 0.52, P less than .01). These data suggest that elevated ACE excretion in NIDDM patients with overt nephropathy may be reflective of renal tubular damage.     

Clinical correlates of painful diabetic neuropathy and relationship of neuropathic pain with sensorimotor and autonomic nerve function

Background: This study investigated the clinical correlates of painful diabetic polyneuropathy (PDPN) and the relationship of neuropathic pain with sensorimotor and autonomic nerve function. Methods: Seventy‐eight diabetic patients with PDPN (PDPN⁺), 57 with non‐painful diabetic polyneuropathy (DPN⁺), and 56 without diabetic polyneuropathy (DPN^?) were prospectively studied. Autonomic neuropathy, neuropathic symptoms and signs, vibration perception threshold, and neuropathic pain were assessed using 4 cardiovascular tests, scoring systems for symptoms and signs (Michigan Diabetic Neuropathy Score, MDNS), Biothesiometer, and a numerical rating scale. Results: Compared to DPN⁺, PDPN⁺ patients displayed higher BMI (P =0.0043), waist circumference (P =0.0057), neuropathy symptom score (P <0.0001), MDNS (P <0.0001), and lower Valsalva ratio (P =0.037). In a multiple logistic regression analysis including PDPN as the dependent variable and age, sex, body mass index (BMI), abdominal obesity, diabetes type, diabetes duration, HbA1c, blood pressure, triglycerides, smoking, peripheral arterial disease, Valsalva ratio and MDNS as the independent variables, BMI (OR 1.22, P =0.0012) and MDNS (OR 1.27, P =0.0005) were significantly and independently associated with PDPN. In a multivariate regression analysis including as independent variables also sex, age, diabetes type, diabetes duration and Valsalva ratio, 24‐h pain score was significantly related to neuropathy symptom score (P =0.0011), MDNS (P =0.0158), and 10 g monofilament (P =0.018). Discussion: BMI and sensorimotor deficits were the main determinants of PDPN and, as a novel finding, neuropathic pain intensity was related to the degree of neuropathy deficits. Thus, some peculiarity exists in metabolic correlates of diabetic neuropathic pain compared to insensate neuropathy but painfulness can still coexist with insensitivity.     

Pupil signs of sympathetic autonomic neuropathy in patients with type 1 diabetes

OBJECTIVE: Pupillary autonomic neuropathy is considered an early sign of the development of systemic autonomic neuropathy. Sympathetic denervation is related to the duration of diabetes and the development of systemic autonomic dysfunction. We investigated pupil responsiveness to directly and indirectly acting sympathomimetics in type 1 diabetic patients with and without long-term complications, defined as cardiac autonomic neuropathy (CAN), peripheral sensomotor neuropathy, retinopathy, and nephropathy, and in healthy subjects. RESEARCH DESIGN AND METHODS: A total of 47 randomly chosen type 1 diabetic patients and 20 healthy subjects were selected for this study. Patients were divided into groups determined by whether they had long-term diabetic complications. Pharmacological tests were performed with cocaine 4%, epinephrine 1%, and pholedrine 5% eye drops. Horizontal pupil diameter (HPD) was measured at the beginning of the pharmacological tests and at defined time points after instillation of the eye drops. RESULTS: Statistical analysis showed a significantly smaller HPD in the patients before instillating eye drops (P = 0.011). In particular, the HPD was significantly smaller in the patient group without CAN when compared with healthy subjects (P = 0.004). Maximal cocaine reaction was diminished in the complication group (P < 0.001). Epinephrine test, visual acuity, ocular pressure, and HbA(1c) did not differ in patients with or without long-term complications. The noncomplication group showed no significant differences in pupillary responses as compared with healthy subjects. The complication group showed a smaller HPD (P = 0.022), reduced pupillary responses in the cocaine (P = 0.037) and pholedrine tests (P < 0.001), and anisocor pupil sizes after instillation of the eye drops (P = 0.034). CONCLUSIONS: Our results clearly show that sympathetic denervation does exist in the pupil of diabetic patients and that it can be rapidly assessed using the cocaine test. These data and the results of the epinephrine test suggest a mixed pre- and postganglionic dysfunction of the sympathetic plexus. The significant smaller HPD in patients without CAN compared with that of healthy subjects could be a sign for early involvement of the pupil function before cardiac manifestation of systemic autonomic diabetic neuropathy.     

Analysis of antibodies against components of the autonomic nervous system in diabetes mellitus

Antibodies to autonomic nervous system structures have previously been detected using a complement fixation immunofluorescence test in the sera of patients with insulin-dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM). These antibodies might play a role in the aetiology of autonomic neuropathy. Sera from 45 IDDM, 40 NIDDM and 52 control subjects were tested by immunofluorescence for antibodies to human sympathetic ganglia, human adrenal medulla and rabbit vagus nerve. The use of human sympathetic ganglia was compared with rabbit tissue for the detection of sympathetic ganglia antibodies; the results for these autonomic nervous system antibodies were also compared with results using an ELISA. There was no relationship between the presence of antibodies detected by ELISA and those detected by immunofluorescence, but of 14 IDDM patients with thyroid antibodies, 12 had autonomic nervous system antibodies detected by either immunofluorescence or ELISA (p < 0.005 compared to patients without thyroid antibodies). To further characterize the autoantigen(s), immunoblotting was performed. An adrenal antigen corresponding to 74 kDa was detected in sera from three patients, only one of whom had antibodies detectable by ELISA and immunofluorescence. One IDDM serum showed specific binding to a vagus nerve antigen corresponding to 33 kDa. No specific binding to sympathetic ganglia antigen was demonstrated. Antibodies against autonomic nervous system antigens are an inconsistent feature of diabetes, and appear more associated with coincidental autoimmunity against other organs such as the thyroid.